Radiotherapy & Oncology
Volume 93, Issue 2 , Pages 168-173, November 2009

Comparison of three radiotherapy modalities on biochemical control and overall survival for the treatment of prostate cancer: A systematic review

  • Bradley R. Pieters

      Affiliations

    • Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
    • Corresponding Author InformationCorresponding author. Address: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, Z0-416, 1100 DD Amsterdam, The Netherlands.
    • ,
  • Djuna Z. de Back

      Affiliations

    • Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
    • ,
  • Caro C.E. Koning

      Affiliations

    • Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
    • ,
  • Aeilko H. Zwinderman

      Affiliations

    • Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands

Received 25 May 2009; received in revised form 7 July 2009; accepted 17 August 2009. published online 14 September 2009.

Abstract 

Background and Purpose

For the radiation treatment of prostate cancer high dose should be delivered for optimal biochemical control. Treatment can be given by dose-escalated external beam radiotherapy (EBRT) or external beam radiotherapy combined with a radioactive seed implantation (EBSeeds) or high-dose rate (HDR) brachytherapy (EBTI). Differences in outcome between the modalities were assessed by a systematic review.

Materials and methods

A systematic search was performed resulting in 40 articles to be used. Data were extracted on biochemical control and overall survival at 3, 5, and 8years and other time points mentioned in the articles. Also known prognostic parameters were noted. Comparison of the modalities was done by a Weibull survival analysis and estimation of Hazard Ratio’s (HR) was done with 95% confidence intervals (95% CIs).

Results

The HR for biochemical recurrence was 1.40 (95% CI 1.31–1.51) for EBRT relative to EBTI, and was 1.37 (95% CI 1.26–1.49) for EBSeeds relative to EBTI. The HR for overall survival was 1.50 (95% CI 1.29–1.73) for EBRT relative to EBTI, and was 2.33 (95% CI 2.04–2.66) for EBSeeds relative to EBTI.

Conclusion

The combination of external beam radiotherapy and HDR brachytherapy results in a superior biochemical control and overall survival found in a systematic review on radiotherapy for prostate cancer.

Keywords: Prostate neoplasms, Systematic review, Meta-analysis, Dose-escalated radiotherapy, Brachytherapy

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PII: S0167-8140(09)00465-4

doi:10.1016/j.radonc.2009.08.033

Radiotherapy & Oncology
Volume 93, Issue 2 , Pages 168-173, November 2009

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